| 1. |
- Jonsson, Ann-Sofie, et al.
(författare)
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Older patients' perspectives on mealtimes in hospitals : a scoping review of qualitative studies
- 2021
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Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 35:2, s. 390-404
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Tidskriftsartikel (refereegranskat)abstract
- The increasing age of populations throughout the world means that healthcare services are faced with new challenges, not least regarding the provision of food during hospital stay. There is a lack of knowledge of how hospital mealtimes are experienced by older patients, and so the aim of this article was to review current knowledge regarding mealtimes in hospitals from the perspectives of older patients. A literature search was performed using seven databases: PubMed, Web of Science, Scopus, Sociological Abstracts, SweMed+, ASSIA and CINAHL with no limits regarding publication date. The inclusion criteria were peer-reviewed articles in English or Swedish that used qualitative methods to examine older patients' (>65 years) mealtime experiences. The Five Aspect Meal Model (FAMM) served as a framework for understanding the complexity behind a mealtime experience. Qualitative content analysis was used as a guide when analysing the material. The search produced 415 studies, 14 of which were included in the review. The findings generated three main themes for understanding how older patients experience mealtimes while in hospital: (1) the food and the food service, (2) mealtime assistance and commensality during mealtimes and (3) the importance of retaining one's independence. The review also clearly indicated a shortage of studies that solely focus on older patients' experiences of their mealtime. More research is therefore needed to be fully able to understand the complex task of providing meals in hospitals.
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| 2. |
- Jonsson, Ann-Sofie, 1983-, et al.
(författare)
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Experiencing hospitality through people, places and artefacts within an institutional setting : A qualitative interview study with eleven in patients across three hospital wards in Sweden
- 2020
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Ingår i: Nordic Association for Food Studies Workshop 2020. - : Örebro University. - 9789187789434 - 9789187789441 ; , s. 23-23
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Konferensbidrag (refereegranskat)abstract
- Eating and sharing meals are essential parts of everyday life and expressed through tradition and culture. This everyday expression of who we are is argued to be taken away from us during hospitalization. Few studies have qualitatively explored hospitalized older patients experiences with their mealtimes. This is a perspective that could increase the understanding of how to provide enhanced dining experiences during time of illness for this malnutrition prune age group. The study objective was therefore to explore older patients’ (> 65 years) mealtime experiences during hospital stay with an emphasis towards the social interactions taking place before, during and after their meals. Eleven semi structured interviews were conducted and analysed through the lens of hospitality and the dramaturgical theory outlined by Goffman. The preliminary results indicate that the patients experience hospitality through materiality (e.g. the menu), commensality (with fellow patients and staff) an d individuality (the possibility to make own meal choices) but also inhospitality through conformity (not expressing their wishes or conforming to the situation) and locality (e.g. being lonely in ther oom). The patients are seen to reinforce the role of the non-complaining patient as well as not being a burden. The understanding of these kinds of role making and role taking by the patients is important to recognize within healthcare to be able to ensure that the mealtime and the meal service is provided with a person- centered approach together with the recognition that hospitality can bring fourth the practical doings in how to perform during meal service.
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| 3. |
- Jonsson, Ann-Sofie, 1983-, et al.
(författare)
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Hospitality and mealtime approaches in hospitals – perspectives from nursing- and meal-staff
- 2020
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Ingår i: The INC 2020. ; , s. 98-99
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Konferensbidrag (refereegranskat)abstract
- In order to understand the provision of meals to older patients in hospitals, the notion of hospitality is interesting. Previous research has found that even if adequate nutrition is provided the food served to the patients is not always consumed (Agarwal et al. 2013). Therefore, it is essential to also highlight aspects related to how and where the meals areserved, as well as the interaction between the staff and the patients.The overall aim of this study was to explore how nursing staff and meal-hosts approached the mealtime for older patients and what aspects impacted on how the meals were served to the patients.Method: Twenty mealtimes was observed across four wards within two hospitals in Sweden that had nursing staff serving meals on wards with a dayroom (2 wards) and meal-host serving meals on the wards with a dining room (2 wards). The objectives of the observations was to observe how the staff served the meals to the patients with as special focus on the hospitality approaches provided and the overall dining area. The Five Aspect Meal Model (Gustafsson, Öström, Johansson & Mossberg, 2006; Edwards & Gustafsson, 2008) and the notion of hospitality (Lashley, 2000; Telfer, 2000) serves as main frameworks. Moreover, Goffman’s dramaturgical theory (Goffman, 2014) is used to understand the scenery observed during the mealtimes.Preliminary findings: Two overall themes were identified in the initial analyses, 1) atmosphere in the dining area; 2) and serving style and hospitality approaches.The overall atmosphere differed between the two dining areas which impacted on how the patients were approached during mealtimes. The observations disclosed several encounters were the atmosphere in the dining area in the wards with meal-hosts serving were perceived as a regular restaurant with patients approached and asked what they would like to eat and drink in relation to the menu that was available. It was also observed in several occasions that the meal-host sat down next to the patients and helped the patients to choose a dish from the menu, asking if they were satisfied with the meal or if they needed anything else. The meal-host constant presence in the dining room contributed to a positive atmosphere as well as opportunities for the patients to get direct assistance. In the wards with nursing staff serving the food in the dayroom the patients were not as frequently out for lunch or dinner and several observations disclosed that no patients were taken to dine outside the own room. However, when the patients were out the hospitality approaches differed. Most often the patients were nicely talked and attended to in the moment of providing the meal tray and when the tray was taken away. However, the time between service and closing of the meal the patients was most often left unattended for. The atmosphere was most often sensed as “heavy” and silent. It was observed that the nursing staff not always thought of turning the lights on in the dayroom contributing to a less positive atmosphere. The staff was observed to just passing by the dayroom without visiting the dayroom to ask if the meal was of satisfaction or overall seeing the patients.The serving style and hospitality approaches differed in some aspects between meal-hosts and nursing staff at the observed wards. The nursing staff was observed on all wards, including the wards with meal-host serving the meals, to be more hands-on and talking closer with the patients, which also disclosed different caring roles during mealtimes. If patients wanted anything else, a hand was often seen to be touched upon the patient or confirmed the wish by talking near and close to the patient. The meal-host was observed to both display a near service style with taking orders by sitting next to the patient or squatting to be on the same level as the patient, and, in some occasions, take orders as in restaurants with the help of a note pad standing next to the table.Conclusion: The preliminary findings of this study indicate that a constant presence of a meal-host or nursing staff would be beneficial for both the overall atmosphere in the dining area as well as for patients getting timely assistance. However, further analyses are needed to fully understand and report the findings of this study.
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| 4. |
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| 5. |
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| 6. |
- Jonsson, Ann-Sofie, 1983-, et al.
(författare)
-
Older patients' perspectives on mealtimes in hospitals : a scoping review of qualitative studies
- 2021
-
Ingår i: Scandinavian Journal of Caring Sciences. - : John Wiley & Sons. - 0283-9318 .- 1471-6712. ; 35:2, s. 390-404
-
Forskningsöversikt (refereegranskat)abstract
- The increasing age of populations throughout the world means that healthcare services are faced with new challenges, not least regarding the provision of food during hospital stay. There is a lack of knowledge of how hospital mealtimes are experienced by older patients, and so the aim of this article was to review current knowledge regarding mealtimes in hospitals from the perspectives of older patients. A literature search was performed using seven databases: PubMed, Web of Science, Scopus, Sociological Abstracts, SweMed+, ASSIA and CINAHL with no limits regarding publication date. The inclusion criteria were peer‐reviewed articles in English or Swedish that used qualitative methods to examine older patients’ (>65 years) mealtime experiences. The Five Aspect Meal Model (FAMM) served as a framework for understanding the complexity behind a mealtime experience. Qualitative content analysis was used as a guide when analysing the material. The search produced 415 studies, 14 of which were included in the review. The findings generated three main themes for understanding how older patients experience mealtimes while in hospital: (1) the food and the food service, (2) mealtime assistance and commensality during mealtimes and (3) the importance of retaining one’s independence. The review also clearly indicated a shortage of studies that solely focus on older patients’ experiences of their mealtime. More research is therefore needed to be fully able to understand the complex task of providing meals in hospitals.
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| 7. |
- Jonsson, Ann-Sofie, 1983-
(författare)
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The "ity" factor in hospital meals : Performing, experiencing, and understanding hospitality within the hospital frame
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to explore how the notion of hospitality could be used as a perspective to understand the meal provision within a hospital frame. Of interest was how patients (>65 years of age) experience their mealtimes together with perspectives from the ones serving the meals. This is motivated by older adult patients being more affected by malnutrition and having more challenges during mealtimes than other patient groups. Previous research has identified the importance of assistance during mealtimes and the implications that staff can have for patients’ food intakes. However, few studies have been found that focus on older adult patients’ own experiences of meal provision from a qualitative approach, nor studies that have focused on the practical doings by the staff.The thesis is grounded in an interpretive perspective viewing social reality as constructed and experienced in relation to how one interacts with other subjects as well as objects, by applying the theory of symbolic interactionism together with Goffman’s dramaturgical theory. In addition, the FAMM was used to understand the entirety of the meal experience, and the person-centred care approach to understand the study setting of interest.The fieldwork was conducted across four wards at two Swedish public hospitals, and interviews were conducted at three of these wards. In total, 20 mealtime observations together with 11 interviews with patients and 20 interviews with staff in different categories were conducted. The wards differed in relation to the dining room environment, the role of the meal host and how the meal service was conducted.The overall findings reflect these differences by suggesting that the meal provision needs to be understood as a balancing act, where the staff perform in front of the patients in relation to the hospitability provided by the organisational host. The patients experienced hospitality through being acknowledged and recognised together with unexpected moments of hospitality. In turn, the staff were found to be knowing and caring in their performances towards the patients as well as showing professional knowledge when reading between the lines and offering what not always was voiced.The findings identify a need by the staff to be able to have more time with the patients, having the ability to perform a meal service in a timely manner as well as the ability to navigate within the organisational frames. Demonstrating the need for, as well as the presence of, the “ity” factor in hospital meals.
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| 8. |
- Adjeiwaah, Mary, 1980-
(författare)
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Quality assurance for magnetic resonance imaging (MRI) in radiotherapy
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The use of Magnetic Resonance Imaging (MRI) in the radiotherapy (RT) treatment planning workflow is increasing. MRI offers superior soft-tissue contrast compared to Computed Tomography (CT) and therefore improves the accuracy in target volume definitions. There are, however concerns with inherent geometric distortions from system- (gradient nonlinearities and main magnetic field inhomogeneities) and patient-related sources (magnetic susceptibility effect and chemical shift). The lack of clearly defined quality assurance (QA) procedures has also raised questions on the ability of current QA protocols to detect common image quality degradations under radiotherapy settings. To fully implement and take advantage of the benefits of MRI in radiotherapy, these concerns need to be addressed.In Papers I and II, the dosimetric impact of MR distortions was investigated. Patient CTs (CT) were deformed with MR distortion vector fields (from the residual system distortions after correcting for gradient nonlinearities and patient-induced susceptibility distortions) to create distorted CT (dCT) images. Field parameters from volumetric modulated arc therapy (VMAT) treatment plans initially optimized on dCT data sets were transferred to CT data to compute new treatment plans. Data from 19 prostate and 21 head and neck patients were used for the treatment planning. The dCT and CT treatment plans were compared to determine the impact of distortions on dose distributions. No clinically relevant dose differences between distorted CT and original CT treatment plans were found. Mean dose differences were < 1.0% and < 0.5% at the planning target volume (PTV) for the head and neck, and prostate treatment plans, respectively. Strategies to reduce geometric distortions were also evaluated in Papers I and II. Using the vendor-supplied gradient non-linearity correction algorithm reduced overall distortions to less than half of the original value. A high acquisition bandwidth of 488 Hz/pixel (Paper I) and 488 Hz/mm (Paper II) kept the mean geometric distortions at the delineated structures below 1 mm. Furthermore, a patient-specific active shimming method implemented in Paper II significantly reduced the number of voxels with distortion shifts > 2 mm from 15.4% to 2.0%.B0 maps from patient-induced magnetic field inhomogeneities obtained through direct measurements and by simulations that used MR-generated synthetic CT (sCT) data were compared in Paper III. The validation showed excellent agreement between the simulated and measured B0 maps.In Paper IV, the ability of current QA methods to detect common MR image quality degradations under radiotherapy settings were investigated. By evaluating key image quality parameters, the QA protocols were found to be sensitive to some of the introduced degradations. However, image quality issues such as those caused by RF coil failures could not be adequately detected.In conclusion, this work has shown the feasibility of using MRI data for radiotherapy treatment planning as distortions resulted in a dose difference of less than 1% between distorted and undistorted images. The simulation software can be used to produce accurate B0 maps, which could then be used as the basis for the effective correction of patient-induced field inhomogeneity distortions and for the QA verification of sCT data. Furthermore, the analysis of the strengths and weaknesses in current QA tools for MRI in RT contribute to finding better methods to efficiently identify image quality errors.
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| 10. |
- Andermo, Susanne, et al.
(författare)
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School-related physical activity interventions and mental health among children : a systematic review and meta-analysis.
- 2020
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Ingår i: Sports medicine - open. - : Springer Science and Business Media LLC. - 2199-1170 .- 2198-9761. ; 6:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Low levels of physical activity, sedentary behaviour and mental health problems are issues that have received considerable attention in the last decade. The aim of this systematic review and meta-analysis was to investigate effects of interventions targeting school-related physical activity or sedentary behaviour on mental health in children and adolescents and to identify the features of effective interventions.METHODS: Scientific articles published between January 2009 and October 2019 fulfilling the following criteria were included: general populations of children and adolescents between age 4 and 19, all types of school-related efforts to promote physical activity or reduce sedentary behaviour. Study selection, data extraction and quality assessment were done by at least two authors independently of each other. Data were analysed with a random effects meta-analysis and by narrative moderator analyses.RESULTS: The literature search resulted in 10265 unique articles. Thirty-one articles, describing 30 interventions, were finally included. Eleven relevant outcomes were identified: health-related quality of life, well-being, self-esteem and self-worth, resilience, positive effect, positive mental health, anxiety, depression, emotional problems, negative effect and internalising mental health problems. There was a significant beneficial effect of school-related physical activity interventions on resilience (Hedges' g = 0.748, 95% CI = 0.326; 1.170, p = 0.001), positive mental health (Hedges' g = 0.405, 95% CI = 0.208; 0.603, p = < 0.001), well-being (Hedges' g = 0.877, 95% CI = 0.356; 1.398, p = < 0.001) and anxiety (Hedges' g = 0.347, 95% CI = 0.072; 0.623, p = 0.013). Heterogeneity was moderate to high (I2 = 59-98%) between studies for all outcomes except positive effect, where heterogeneity was low (I2 = 2%). The narrative moderator analyses of outcomes based on 10 or more studies showed that age of the children moderated the effect of the intervention on internalising mental health problems. Interventions in younger children showed a significantly negative or no effect on internalising mental health problems while those in older children showed a significant positive or no effect. Moreover, studies with a high implementation reach showed a significant negative or no effect while those with a low level of implementation showed no or a positive effect. No signs of effect moderation were found for self-esteem, well-being or positive mental health. Risk of publication bias was evident for several outcomes, but adjustment did not change the results.CONCLUSIONS: School-related physical activity interventions may reduce anxiety, increase resilience, improve well-being and increase positive mental health in children and adolescents. Considering the positive effects of physical activity on health in general, these findings may reinforce school-based initiatives to increase physical activity. However, the studies show considerable heterogeneity. The results should therefore be interpreted with caution. Future studies should report on implementation factors and more clearly describe the activities of the control group and whether the activity is added to or replacing ordinary physical education lessons in order to aid interpretation of results.TRIAL REGISTRATION: PROSPERO, CRD42018086757.
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